Bio-identical Hormone Therapy

Selected References

1. Fitzpatrick La et al. Comparison of regimens containing oral micronized progesterone of medroxyprogesterone acetate on quality of life in postmenopausal women: a cross-sectional survey. J Womens Health Gen Based Med 2000 Mayu;9(4):381-7

2. Gompel et al. Antiestrogen action of progesterone in breast tissue. Breast cancer Res Treat 1986;8(3):179-88.

4. Hulka BS, Links between hormone replacement therapy and neoplasia. Fertil Steril 1994 Dec;62(6 Suppl 2):168S-175S.

6. Hofseth LJ; Raafat AM; Osuch JR; Pathak DR; Slomski CA; Haslam SZ Hormone replacement therapy with estrogen or estrogen plus medroxyprogesterone acetate is associated with increased epithelial proliferation in the normal postmenopausal breast. J Clin Endocrinol Metab 1999 Dec;84(12):4559-65.

8. Foidart JM; Colin C; Denoo X; Desreux J; Beliard A; Fournier S; de Lignieres B. Estradiol and progesterone regulate the proliferation of human breast epithelial cells. Fertil Steril 1998 May;69(5):963-9

7. Estrogen Replacement therapy and Heart Disease: A Discussion of the PEPI Trial. Women’s Health Information Center.

8. Rosano GM; Webb CM; Chierchia S; Morgani GL; Gabraele M; Sarrel PM; de Ziegler D; Collins P. Natural progesterone, but not medroxyprogesterone acetate, enhances the beneficial effect of estrogen on exercise-induced myocardial ischemia in postmenopausal women. J Am Coll Cardiol 2000 Dec;36(7):2154-9.

9. Clarkson TB. Progestogens and cardiovascular disease. A critical review. J Reprod Med 1999 Feb;44(2 Suppl):180-4

10. Feeman WE. Thrombotic stroke in an otherwise healthy middle-aged female related to the use of continuous-combined conjugated equine estrogens and medroxyprogesterone acetate. J Gend Specif Med 2000 Nov-Dec;3(8):62-4; discussion 64-5.

12. Sitruk-Ware R. Progestins and cardiovascular risk markers. Steroids 2000 Oct-Nov;65(10-11):651-8.

13. Colditz Ga. Hormones and breast cancer: evidence and implications for consideration of risks and benefits of hormone replacement therapy. J Womens Health 1999 Apr;8(3):354-7.

14. Tzingounis VA; Aksu MF; Greenblatt RB Estriol in the management of the menopause JAMA 1978 Apr 21;239(16):17

15. Lemon HM; Wotiz HH; Parsons L; Mozden PJ Reduced estriol excretion in patients with breast cancer prior to endocrine therapy. JAMA 1966 Jun 27;196(13):1128-36.

16. Lemon, H.M. Pathophysiologic considerations tin the treatment of menopausal patients with oestrogens; the role of oestriol in the prevention of mammary carcinoma. Acta Endocrinol Suppl 1980 233:17-27. DNH

17. Follingstad AH Estriol, The Forgotten Estrogen. JAMA Jan 2 1978, 23

18. Cowan LD; Gordis L; Tonascia JA; Jones GS. Breast cancer incidence in women with a history of progesterone deficiency. Am J Epidemiol 1981 Aug;114(2):209-17

19. Braunsberg HA; Coldham NG; Wong W. Hormonal therapies for breast cancer: can progestogens stimulate growth?. Cancer Lett 1986 Feb;30(2):213-8

20. Effects of estrogen or estrogen/progestin regimens on heart disease risk factors in postmenopausal women. The Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial. The Writing Group for the PEPI Trial. JAMA 1995 Jan 18;273(3):199-208

21. Hargrove JT, et al. menopausal hormone replacement therapy with continuous daily oral mircronized progesterone. Obstet Gyn 1989;73:606-12.

22. Hargrove, Osteen KG. An alternative method of hormone replacement therapy using the natural sex steroids. Infertile Repro Med Clinics north Am. 1995;6:563-674.DNH

23. Hargrove JT, Eisenberg E. Menopause. Med. Clinics North Am 1995;79:1337-1356.

24. Lemon Hm. Antimammary carcinogenic activity of 17-alpha-ethnyl estriol. Cancer 1987;60:2873-81.

25. Schneider J, Huh MM, Bradlow HL, Fishman J. (1984), Antiestrogen action of 2-hydroxyestrone on MCF-7 human breast cancer cells. J Biol Chem 259:4840-4845.

26. Vandewalle B, Lefebvre J. (1989), Opposite effects of estrogen and catechol estrogen on hormone-sensitive breast cancer cell growth and differentiation. Mol Cell Endocrinol 61:239-246.

27. Bradlow HL, Telang NT, Sepkovic DW, Osborne MP. (1996), 2-hydroxyestrone: the ‘good’ estrogen. J Endocrinol 150:Suppl: S259-S265.

28. Fishman J, Martucci C. (1980), Biological properties of 16alpha-hydroxyestrone: Implications in estrogen physiology and pathophysiology. J Clin Endocrinol Metab 51:611-615. DNH

29. Osborne MP, Bradlow HL, Wong GYC, Telang NT. (1993), Upregulation of estradiol C16 alpha-hydroxylation in human breast tissue: a potential biomarker of breast cancer risk. J Natl Cancer Inst 85:19

30. de Lignieres B. Oral micronized progesterone. Clin Ther 1999. jan;21(1):41-60.

31. Fitzpatrick LA, Good A. Micronized progesterone: clinical indications and comparison with current treatment. Fertil Steril 1999 Sept;72(3):389-97.

32. Adams MR; Register TC; Golden DL; Wagner JD; Williams JK Medroxyprogesterone acetate antagonizes inhibitory effects of conjugated equine estrogens on coronary artery atherosclerosis Arterioscler Thromb Vasc Biol 1997 Jan;17(1):217-21 (ISSN: 1079-5642

33. Wagner JD; Martino MA; Jayo MJ; Anthony MS; Clarkson TB; Cefalu WT. The effects of hormone replacement therapy on carbohydrate metabolism and cardiovascular risk factors in surgically postmenopausal cynomolgus monkeys. Metabolism 1996 Oct;45(10):1254-62

34. Lemon Hm. Oestriol and prevention of breast cancer. Lancet 1973;march 10:546-7.

35. Bulbrook RD; Swain MC; Wang DY; Hayward JL; Kumaoka S; Takatani O; Abe O; Utsunomiya J. Breast cancer in Britain and Japan: plasma oestradiol-17beta, oestrone and progesterone,and their urinary metabolites in normal British and Japanese women. Eur J Cancer 1976 Sep;12(9):725-35.

36.Speroff L. The breast as an endocrine target organ. Contemp Obst Gyn 1977 9:69-72. DNH

37. Tikkanen MJ; Kuusi T; Nikkila EA; Sipinen S. Post-menopausal hormone replacement therapy: effects of progestogens on serum lipids and lipoproteins. A review. Maturitas 1986 Mar;8(1):7-17.

38. Newham HH. Oestrogens and atherosclerotic vascular disease: lipid factors. Baillieres Clin Endo Metab 1993;7:61-93.

39. Lobo RA. The role of progestins in hormone replacement therapy. Am J Obstet Gynecol 1992 Jun;166(6 Pt 2):1997-2004

40. Bolaji II; Grimes H; Mortimer G; Tallon DF; Fottrell PF; O'Dwyer EM. Low-dose progesterone therapy in oestrogenised postmenopausal women: effects on plasma lipids, lipoproteins and liver function parameters. Eur J Obstet Gynecol Reprod Biol 1993 Jan;48(1):61-8.

41. Moorjani S; Dupont A; Labrie F; De Lignieres B; Cusan L; Dupont P; Mailloux J; Lupien PJ. Changes in plasma lipoprotein and apolipoprotein composition in relation to oral versus percutaneous administration of estrogen alone or in cyclic association with utrogestan in menopausal women. J Clin Endocrinol Metab 1991 Aug;73(2):373-9.

42. Jensen J; Riis BJ; Strom V; Nilas L; Christiansen C. Long-term effects of percutaneous estrogens and oral progesterone on serum lipoproteins in postmenopausal women. Am J Obstet Gynecol 1987 Jan;156(1):66-71.

43. Ottosson UB; Johansson BG; von Schoultz B. Subfractions of high-density lipoprotein cholesterol during estrogen replacement therapy: a comparison between progestogens and natural progesterone. Am J Obstet Gynecol 1985 Mar 15;151(6):746-50.

44. Elkind-Hirsch KE; Sherman LD; Malinak R. Hormone replacement therapy alters insulin sensitivity in young women with premature ovarian failure. J Clin Endocrinol Metab 1993 Feb;76(2):472-5.

45. Bush TL; Barrett-Connor E; Cowan LD; Criqui MH; Wallace RB; Suchindran CM; Tyroler HA; Rifkind BM. Cardiovascular mortality and noncontraceptive use of estrogen in women: results from the Lipid Research Clinics Program Follow-up Study. Circulation 1987 Jun;75(6):1102-9.

46. Godsland IF; Gangar K; Walton C; Cust MP; Whitehead MI; Wynn V; Stevenson JC. Insulin resistance, secretion, and elimination in postmenopausal women receiving oral or transdermal hormone replacement therapy. Metabolism 1993 Jul;42(7):846-53.

47. Morey AK; Pedram A; Razandi M; Prins BA; Hu RM; Biesiada E; Levin ER. Estrogen and progesterone inhibit vascular smooth muscle proliferation. Endocrinology 1997 Aug;138(8):3330-9

 

BIO-IDENTICAL HORMONES

 

Frequently Asked Questions

 

I haven’t reached menopause yet, but I feel like I have a lot of the symptoms.  Can I take hormone replacement or supplements to help?

Women who are perimenopausal, (the time when hormone levels drop, symptoms begin, but menstrual cycles persist) often experience a significant change in the way they feel.  This is because the normal hormone levels of youth are dropping despite the fact that menses persist.  Many women are successfully treated with bio-identical hormone therapy to help to re-balance their hormone levels and help them to feel like they did when they were younger.  Each woman is treated individually to fit their specific needs.

 

What makes the natural hormones different from the other hormones like Premarin, Provera and Estradiole?

Women naturally produce three types of estrogen: estriol (80%), estradiole (10-20%) and estrone (10-20%) as well as progesterone and testosterone.  The hormone replacement therapy (HRT) Premarin was derived from the urine of pregnant mares and contained only estrone, estradiole and estrogens common only to horses, but not women.   If nature made women with MOST of their estrogen being estriol, why are we replacing only the other two? Bio-identical hormones replace hormones in a woman’s body the way nature intended.  Hormone therapy with the Vitapel(tm) hormone pellet implants allows the patient to receive a continuous, consistent dosage of hormones as the body needs them.  The hormones are distributed directly into the bloodstream without affecting the liver and without the side effect of blood clots that occur with oral estrogen therapy.

 

Progesterone was previously supplemented by using Progestin (Provera) instead of the actual substance in a woman’s body.  There were many adverse side effects with the synthetic Progestin as well as some links to breast cancer.  Progesterone in it’s natural form has NO cancer causing effects in studies and helps to restore calmness, mood balance and aids in sleep.  It is also important in the prevention of osteoporosis and possibly breast cancer.

 

Testosterone is made by a women’s body too!  It helps to maintain lean muscle mass, increases energy and sex drive.  It has not been widely recognized in the old HRT therapies.  Testosterone actually reduces the risk of cardiovascular disease, Alzheimers and osteoporosis.

 

I’ve heard a lot about the risks of hormones on the news.  Are these safe to take?

Natural/bio-identical hormones have been studied and found to be safe up to this point. Many more longer term studies are underway and if you go to hormonebalance.org you will find an amazing body of research on the subject put together by Dr Glaser (an internationally recognized expert in the field). To access the data, use the username:data and password:data.  She is currently involved in the use of testosterone in breast cancer patients. The individual components that make up the bioidenticals have been studied extensively and are FDA approved (except for estriol which has been used in Europe for more than half a century).  There are those who believe that this treatment is safe for everyone, but it is my belief that you must be cleared medically first.  This is done at the consultation and may require medical clearance from your primary care MD if needed.

And a few more questions...

I have a lot of different symptoms.  Can they all be treated with bio-identical hormones?

Perimenopause and menopause can cause a multitude of symptoms including:  fatigue, chronic joint pain/fibromyalgia, mental fogginess, mood swings/anxiety, insomnia, weight gain, low or absent sex drive, and more.  Each woman is affected differently by her own body’s response to the hormonal imbalances, but the complaints tend to be fairly similar.  Once other potential medical issues are ruled out, it can be ascertained from a patient’s history whether hormones are causing their problems.  Because each person has different symptoms, each person is given a treatment specific to their needs (different dosages, different combinations of hormones and regimens).

 

What does the initial work-up and treatment consist of?

A detailed consultation (1-2 hours) is done, begining with a patient’s complete medical history as well as their menstrual/GYN history. Current issues and complaints are considered as are diet and exercise habits, social situation and any other contributing factors.  A laboratory work-up is done at a specific time depending on the patient’s current menstrual/hormone situation.  When the laboratory test results are received, the results are evaluated in conjunction with the history, and a final determination of treatment specific to each patient, is formulated and prescribed.  Follow-up visits are required at varying intervals to monitor the patient’s progress and make necessary changes as they occur. Patients are required to have regular follow-up appointments with their primary care practitioners and OB-GYN providers in order to treat the whole person properly. Full women's health services are also available.  All care is coordinated and shared with your providers.

 

How do I get started?

Call to set up your consultation in either my Santa Barbara or Westlake Village location by calling 805-494-8520.